By Emma McGowan

Endometriosis is a disorder that affects approximately 11% of people with uteruses. It’s characterized by tissue similar to the lining of the uterus — called the “endometrium” — growing outside of the uterus. People with endo can have tissue growing all over their pelvic area, including on the outside of the uterus; the outside and inside of the vaginal wall; on the bladder, bowels, fallopian tubes — you name it. The tissue can even fuse organs together, like chewing gum sticking the bladder to the vaginal wall or the bowels to the bladder or the… You get the picture. It’s not great. 

In addition to connecting bits that really aren’t supposed to be connected, that endometrial tissue breaks down monthly, just like the endometrium inside the uterus. But with nowhere to go, it builds up inside the abdominal cavity and causes inflammation and pain. It can even lead to the growth of new blood vessels and nerves. Ouch!! 

Endometriosis is really a one-of-a-kind experience, presenting slightly differently in each person who has it. Some people experience excruciating pain all of the time; some only have pain with their period; some only have pain with penetration. And some have pain with orgasm — while others find that orgasming actually eases their endo symptoms. 

So let’s take a look at orgasms and endometriosis. What’s going on? And is it possible for people in pain to find relief? 

(Spoiler: Yes.) 

What Happens Physically When I Orgasm?

There’s a whole lot going on when a person with vagina has an orgasm. According to legendary sex researchers Masters and Johnson it’s the third of four stages of the sexual response cycle: excitement, plateau, orgasm, and resolution. And while we now know that the Masters and Johnson model has a lot of limitations (the biggest being that they really only focused on penis-in-vagina sex), it still gives a decent general template for us to follow as we understand what happens to the body during orgasm.

During the “excitement” phase (aka when you’re getting more and more turned on), the vagina, vulva, and clitoris swell with blood. That makes all of the (many) nerves in the area more sensitive and also creates the fluid that makes people “wet.” Inside of the body, the vagina lengthens and the cervix and uterus shift upward. At the same time, the internal parts of the clitoris fill up with blood, making the head more sensitive to touch and also pushing nerve endings against the vaginal wall. This continues through the “plateau” phase, during which everything gets increasingly sensitive.

Initial pain in the vaginal wall might have been from restricted or dense clitoral nerves getting more sensitive as they filled with blood. It could also have been from the vagina lengthening — stretching out overly-tight muscles or pulling at organs that have fused together.

At the point of orgasm, all of that tension that’s been building in the first two phases releases in the form of vaginal, pelvic, and uterine contractions. In other words: The pussy pulses! Some people feel those contractions in their uterus, rectum, or even throughout their entire body. 

Then, during the “resolution” phase, everything starts to calm down. The blood drains out of the pelvic area; everything shifts back into place; and the vulva returns to its normal state of lubrication. Pretty cool, huh?

Why Does It Hurt When I Cum? 

For people with endometriosis, all of that moving around can pose a problem. And if you add a penis or dildo or fingers moving in and out to the mix, it’s even more likely to get real painful, real fast. One 2016 study published in the National Library of Medicine found that 47% of the 51 women with endometriosis who participated had some type of sexual dysfunction. When they looked at the stages of endometriosis, 100% of those with “severe” endometriosis had sexual dysfunction, compared with 33.33% of those with “minimal” endometriosis. However, orgasm dysfunction was more common in the “minimal” group than in the “severe” group, which tended to have more problems with desire and pain.  

For Robin, 34, who was diagnosed with endometriosis at age 27 after 13 years of abnormal periods, the pain would start as soon as she became aroused. She’d feel sharp, stabbing pains in her vaginal walls, which “made it very difficult to want to progress in a sexual situation.”

“As soon as anything happened, I was like, ‘Ow!’” Robin says. 

But while she usually orgasms easily, sometimes the pain would get so intense that she would get “derailed” before completion. Sometimes, the orgasms would hurt: a pain she describes as a “muscular tightening.” That was in contrast to the pain she’d feel with penetration, which was more “sharp and stabbing.” But regardless of whether or not she came, any sex acts would kick off a day or two of “awful cramps.” 

While sex and orgasm without pain might seem like a pipe dream to some, it really is possible.

The pain Robin experienced could have come from a few different causes. That initial pain in the vaginal wall might have been from restricted or dense clitoral nerves getting more sensitive as they filled with blood. It could also have been from the vagina lengthening — stretching out overly-tight muscles or pulling at organs that have fused together. And while the experience of pain is subjective and therefore feels different for every person, many people with endo describe nerve pain as “stabbing,” while muscular pain is more likely to feel like a deep ache or extremely painful cramps. 

However, it’s important to note that not everyone with endo experiences pain during orgasm — or even experiences pain during sex. Another study, this one from 2005, which included 309 women with endometriosis diagnoses found that 73% experienced some form of “female sexual dysfunction.” That’s a high number, but it’s not 100%. 

Will I Never Orgasm Again??

Not being able to orgasm — or, for some, not being able to have sex at all — can be a really upsetting part of having endometriosis. It can cause people to avoid sex altogether, which can lead to lower self esteem, anxiety, and even depression. It can also cause relationship problems. For Robin, the fact that she couldn’t stand deep penetration led to real strains on her emotional relationship with her partner.

“Obviously he doesn’t want to hurt me, so the times when I would grin and bear it and be in extreme pain — or even bleeding — afterwards, he would ask ‘Why didn’t you say anything?’ And for me, it was because I liked having sex still and this is just what I had to deal with to have sex.”

But while sex and orgasm without pain might seem like a pipe dream to some, it really is possible. If you’re suffering, the first step is to make an appointment with your gynecologist to get everything checked out. The second step would be to meet with a pelvic floor physical therapist, who can help you determine what exactly is causing the pain and address that underlying cause. For example, if the endometriosis has caused you to clench your pelvic floor and/or abdominal muscles, the PT can help you work out that tension, both in the clinic and with at-home treatments. 

Living with endometriosis can be hard — really hard. But it doesn’t mean the end of orgasms. With some professional help (and might we suggest Pelvic Gym’s endo program?) and a lot of practice, it’s very likely you’ll be able to cum again.